Understanding the TB Cohort Review Process: Instruction Guide 2006

Preparation for a cohort review

• Demonstrate commitment to the cohort review process.
• Ensure staff at all levels understand the reasons for undertaking cohort reviews.
• Ensure staff at all levels have the knowledge and skills needed to perform the tasks required.

Cohort review presentation

• Listen to all case presentations.
• Ask questions of clarification to ensure that all aspects of case management adhere to department of health policies and procedures.
• Use teachable moments to illustrate important lessons in effective TB control.

Follow-up after cohort review

• Ensure that medical management and other issues are addressed.
• Ensure that ongoing, follow-up staff education incorporates program strengths and weaknesses.

• Demonstrate commitment to the cohort review process.
• Ensure staff at all levels understand the reasons for undertaking cohort reviews.

Cohort review presentation

• Listen carefully to all case presentations and review available support documents (e.g., printouts from TB registry, charts, and medical records).
• Ensure that all aspects of case management adhere to department of health policies and procedures.  This includes ensuring that

– Activities are completed in a timely manner

– Data are complete (e.g., date of birth, entry to US, HIV status)

– Drug regimen is appropriate (e.g., probe for explanations for nonstandard regimens)

– Susceptibility results are obtained, drug regimen adjusted if necessary

– Sputum conversion and completion of treatment are documented

– Contact investigation activities and outcomes are assessed

• Ask questions of clarification to make sure policies and procedures were followed and the outcome is satisfactory.
• Use teachable moments to illustrate important lessons in effective TB control.

Follow-up after cohort review

• Ensure that medical management issues are addressed.
• Ensure that ongoing, follow-up staff education incorporates program strengths and weaknesses.

Preparation for a cohort review

• Prepare lists of cases to be reviewed ahead of time: preliminary cohort list 5 months before cohort review, final cohort list 2 months before cohort review.
• Distribute the lists to case managers and supervisors so they can be prepared to present these cases.
• Enter relevant information on each case and contact on the cohort summary sheet.
• Prepare a summary of the current cohort to present at the review session.
• Calculate the outcomes of previous cohort patients who were likely to complete and contacts who were still on treatment for LTBI.

Cohort review presentation

• Present summary of the current cohort of cases.
• Record data on treatment outcomes and other missing information, while the case managers present each case.  Note any issues for clarification.
• Tabulate or calculate the treatment outcomes for cases and contacts; present this at the end of the cohort review session.

Follow-up after cohort review

• Write a report of the cohort review outcomes and distribute it to everyone who has a need to know.

Preparation for a cohort review

• Follow all protocols for case management to ensure that patients adhere to treatment, comply with medical visits, and complete treatment.
• Follow all protocols for contact investigation to ensure that contacts are identified and evaluated, and that they complete treatment for LTBI, if appropriate.
• Communicate periodically with clinic and outreach workers to ensure everything is proceeding without problems; troubleshoot problems.
• Participate in case review meetings with your supervisor and case conference meetings with your TB control team as these are scheduled.
• Ensure a complete job had been done (e.g., all loose ends are tied up, all details are considered, and you have information to answer any questions).
• Prepare a concise presentation of the case according to a standard format.
• Participate in a mock cohort review session to practice your presentation and become accustomed to handling questions that might arise (optional).

Cohort review presentation

• When the TB program manager calls one of your cases, speak loudly and clearly as you deliver your concise presentation.
• Answer questions from the TB program manager, medical reviewer, data analyst, or other TB team members.
• Ask any questions you may have about patient care issues.
• Ask your fellow caseworkers and supervisor to provide any information relevant to your case presentation if necessary.
• Follow-up after cohort review
• Follow up to obtain any missing information or clarify details that were noted during the cohort review.
• Update TB registry information as needed.
• Meet with your supervisor to discuss what went well and what could be improved for the next cohort review in 3 months.
• Continue case management if patient has not completed treatment; continue contact investigation activities until contacts who should start or complete LTBI treatment have done so.

Preparation for a cohort review

• Supervise and assist your case management and contact investigation staff in following protocols.
• Hold one-on-one case review meetings with each staff member.
• Hold periodic case conference meetings with your entire team.
• Troubleshoot problems with staff.
• Make sure staff prepare a concise presentation of the case according to a standard format.
• Hold a mock cohort review session for staff to practice presentation skills.  Ask them the kinds of questions that might arise in a real cohort review.
• Cohort review presentation
• Let staff members speak for themselves.
• Only add something if more detail or confirmation of the approach or activities is required.

Follow-up after cohort review

• Follow up to ensure staff obtain missing information, clarify details, and update TB registry information, as noted during the cohort review.
• Meet with staff as soon as possible to discuss what went well and what could be improved for the next cohort review in 3 months.